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Cyclic exclusive enteral nutrition versus partial enteral nutrition to maintain long-term drug-free remission in paediatric Crohn's disease (CD-HOPE): an open-label, endpoint-blinded, randomised controlled trial
No full textInternational audienceBackgroundFor children with Crohn's disease, there is a marked demand for long-term nutritional treatment strategies to avoid the side-effects related to drug treatment. We aimed to investigate whether paediatric patients with Crohn's disease responding to nutritional induction therapy can be maintained in remission on dietary therapy without the use of medication or surgery.MethodsIn this open-label, endpoint-blinded, randomised controlled trial (CD-HOPE) done in 21 hospitals of the GETAID pédiatrique network in France, eligible patients were aged 6 years to younger than 18 years with Crohn's disease (newly diagnosed or relapsing after drug treatment) who had reached clinical remission (weighted Paediatric Crohn's Disease Activity Index [wPCDAI] ≤12·5) after induction therapy with 6–12 weeks of exclusive enteral nutrition (EEN; 100% of calories). Stratified by age (≤10 years or >10 years) and relapse status, patients were randomly assigned (1:1) using block randomisation to receive either cyclic EEN (C-EEN; 100% of daily caloric requirements) for 2 weeks every 8 weeks for at least six cycles or daily partial enteral nutrition (PEN; 25% of daily caloric requirements) for 52 weeks. Oral MODULEN IBD was used for both. Except for the 2-week intervals of EEN in the C-EEN group, food access was not restricted. The primary endpoint was relapse rate at 12 months. A relapse was defined as: (1) a wPCDAI score greater than 12·5 at two successive visits, or (2) a wPCDAI greater than 12·5 once and the need for Crohn's disease-related surgery, medication, or study exit, or (3) a wPCDAI score continuously greater than 12·5 since the last study visit, or (4) incomplete wPCDAI and moderate or severe Physician Global Assessment at any timepoint. Primary and safety analyses were performed on an intention-to-treat basis. This trial was registered on ClinicalTrials.gov (NCT02201693) and is complete.FindingsBetween Dec 12, 2014, and Sept 4, 2018 (last patient visit Oct 2, 2019), 112 patients were screened and 100 patients (70 boys and 30 girls) were randomly assigned to C-EEN (n=49) or PEN (n=51). Median age of participants was 12 years (IQR 11–13) in the C-EEN group and 13 years (11–14) in the PEN group. At 12 months, 24 (49%) of 49 patients had relapsed on C-EEN compared with 39 (76%) of 51 patients on PEN (adjusted odds ratio 0·29 [95% CI 0·13–0·70], p=0·0051). 19 adverse events occurred in 17 patients: four serious adverse events in four patients on PEN, not related to treatment, and 15 non-serious adverse events in 13 patients (nine in seven patients on C-EEN and six in six patients on PEN). The serious adverse events were all related to Crohn's disease relapse requiring hospitalisation for rescue therapy. Six adverse events were possibly related to study treatment: one patient in the C-EEN group reported transient vomiting and diarrhoea at the start of the first EEN cycle, one patient in the C-EEN group developed anorexia and, in the PEN group, four patients reported either weight loss, nausea, Crohn's disease relapse, or skin infection. No malignancy or death was reported in this study.InterpretationC-EEN was superior to PEN in maintaining clinical remission over 1 year in paediatric patients with Crohn's disease responding to EEN induction therapy. These findings suggest a new way to use nutritional therapy for maintaining drug-free long-term remission in patients with Crohn's disease who are responding to EEN induction therapy.FundingAssistance Publique-Hôpitaux de Paris and Nestlé Health Science
Conception et qualification de guides d'ondes flexibles fonctionnant dans les bandes de fréquences submillimétriques, jusqu'à 220 GHz
No full textMillimeter-wave and submillimeter-wave frequencies (terahertz range), particularly the E (71–76/81–86 GHz), W (75–110 GHz), D (110–170 GHz) and G (140–220 GHz) bands, are attracting growing interest for applications in telecommunications, defense, medical, and aerospace fields. The E and W bands are already used for high-data-rate point-to-point links (“backhauls”), while the D and G bands hold great promise for next-generation ultra-high-frequency wireless communications. However, above 110 GHz, interconnections still rely mainly on rigid metallic waveguides, which are difficult to integrate into compact or constrained systems.This PhD work aims to design a flexible waveguide based on a dielectric–metal combination, consisting of at least one dielectric and one metallic material, with the possible addition of a protective sheath to obtain a final product suited to practical applications. The waveguide must be easy to handle and manufacturing compatible with industrial processes, particularly dielectric extrusion used by the project’s industrial partner. The approach combines the flexibility of dielectric materials with the confinement and shielding properties of metals to produce a flexible, robust, and efficient device operating in the millimeter-wave and submillimeter-wave bands.A literature review was first conducted to analyze existing guiding approaches and interconnection techniques for millimeter-wave propagation. Based on this study, various electromagnetic simulations were performed on the geometry and materials of the waveguide, with the aim of reducing waveguide attenuation constant (dB/m). Two configurations were explored. The first uses a dielectric core wrapped in a metal shielding, while the second is a guide with two dielectrics surrounded by a metal shielding. From the selected geometries, a preliminary simulation study of interconnection concepts between flexible and conventional rigid waveguides was carried out to assess their feasibility and impact on overall performance. This part provides an important outlook for future work.The dielectric properties of the material forming the flexible waveguide core were characterized in the millimeter-wave range to refine model accuracy and improve agreement between simulated and measured results. Flexible waveguide prototypes were then fabricated and characterized. The first configuration shows promising results in the W band with losses around 10 dB/m. For the second configuration, the results confirm feasibility and demonstrate good performance in the G band, with controlled losses (< 18 dB/m) and mechanical flexibility allowing handling without significant degradation of wave propagation. To the best of our knowledge, this prototype represents the first manipulable flexible waveguide operating in the G band.This work paves the way for new millimeter- and submillimeter-wave interconnection architectures integrating flexible and adaptable links, offering a unique balance between electromagnetic performance, mechanical flexibility, and industrial manufacturability.Les ondes millimétriques et submillimétriques (fréquences térahertz), et plus précisément les bandes de fréquences E (71 - 76/81 – 86 GHz), W (75 – +110 GHz), D (110 – 170 GHz) et G (140 - 220 GHz), suscitent un intérêt croissant pour des applications dans les domaines des télécommunications, de la défense, du médical ou encore de l’aérospatial. Les bandes E et W sont déjà exploitées pour les liaisons point à point à haut débit (« backhauls »), tandis que les bandes D et G offrent des perspectives prometteuses pour les futures générations de communications sans fil à très hautes fréquences. Cependant, au-delà de 110 GHz, les interconnexions reposent encore principalement sur des guides d’ondes métalliques rigides, peu adaptés aux systèmes compacts et difficiles à intégrer dans des environnements contraints.L’objectif de cette thèse est de concevoir un guide d’ondes flexible reposant sur une combinaison diélectrique-métal, constituée d’au moins un matériau diélectrique et d’au moins un matériau métallique, avec l’ajout éventuel d’une gaine de protection en vue d’un produit final adapté aux applications visées. Le guide doit être facilement manipulable et de fabrication compatible avec les procédés industriels, notamment l’extrusion du matériau diélectrique mise en œuvre par le partenaire du projet. Dans cette optique, la démarche consiste à allier la souplesse des matériaux diélectriques aux propriétés de confinement et de blindage offertes par les matériaux métalliques, afin d’obtenir un dispositif flexible, robuste et performant dans les bandes millimétriques et submillimétriques.Une étude bibliographique a d’abord été menée afin d’analyser les approches de guidage et les connectiques existantes pour les ondes millimétriques. À partir de cette analyse, diverses simulations électromagnétiques ont été effectuées sur la géométrie et les matériaux constitutifs du guide, dans le but de réduire l’affaiblissement linéique du guide d’ondes (dB/m). Deux approches ont été examinées. La première met en œuvre un cœur diélectrique entouré d’une enveloppe métallique, tandis que la seconde est un guide à double diélectriques entourés d’une enveloppe métallique. Sur la base des géométries retenues, une étude préliminaire sur les solutions d’interconnexion entre les guides d’ondes flexibles et les structures rigides conventionnelles a également été menée en simulation, afin d’évaluer leur faisabilité et leur impact sur un assemblage complet. Cette partie constitue une perspective importante pour la suite des travaux.Les propriétés diélectriques du matériau constituant le cœur du guide flexible ont été caractérisées en bandes millimétriques afin d’affiner la précision des modèles et d’améliorer l’accord entre les résultats de simulation et de mesures. Des prototypes de guides flexibles ont ensuite été fabriqués puis caractérisés. La première approche est intéressante en bande W avec pertes autour de 10 dB/m. Pour la seconde approche, les résultats obtenus valident la faisabilité et montrent de bonnes performances en bande H (220–330 GHz), avec des pertes maîtrisées (< 18 dB/m) et une flexibilité mécanique permettant leur manipulation sans dégradation notable du guidage. À notre connaissance, ce prototype est le premier guide d’ondes flexible manipulable fonctionnant en bande H.Ces travaux ouvrent la voie à de nouvelles architectures de liaisons submillimétriques et millimétriques intégrant des interconnexions souples et adaptables, offrant un compromis inédit entre performances électromagnétiques, flexibilité mécanique et faisabilité industrielle
Porous NaTi<sub>2</sub>(PO<sub>4</sub>)<sub>3</sub>-PVDF Composite Granules as Negolyte Boosters for Sodium-Based Redox-Targeting Flow Batteries
No full textInternational audienceRedox-Targeting Flow Batteries (RTFBs) are promising alternatives to classical vanadium-based batteries for large-scale and stationary energy storage. Typically, RTFBs are marked by higher energy densities thanks to the addition of solid boosters within aqueous systems, taking care to limit the use of critical raw materials. This work subsequently investigates the case of sodium titanium phosphate (NTP, NaTi2(PO4)3, 132.8 mAh/g) as a potential booster material for the negolyte side of aqueous RTFBs. Pure NTP and carbon-coated NTP (C-NTP) particles were synthesized and characterized by various techniques (X-ray, TEM, TGA, Raman). So-obtained NTP and C-NTP particles were found to be suitable for creating innovative porous composite boosters formed as centimeter-sized granules by dry processing. Porous composite granules with an open porosity of 65% and 50 wt % of immobilized NTP or C-NTP were successfully produced by an extrusion–dissolution process using a regular PVDF binder and PEO as a porogen agent. Subsequently, intensive electrochemical tests were performed using an innovative dual-mediator reaction system (Fe-Tiron and 2,7-AQDS). High NTP reactivity, with booster utilization rates of up to 84% of its theoretical capacity, can be achieved under flow conditions, with an increase in volumetric capacity by a factor of 1.5, from 4 Ah L–1 to 6 Ah L–1. The mediator concentration (10 – 100 mM) and the mediator/booster ratio (0.5 – 1) play key roles in NTP reactivity. The fundamental work also highlights the benefit of C-NTP, allowing higher reactivity at low mediator concentrations. The study consequently validates the potential of NTP as an interesting booster material in future RTFB applications, with its scalable extrusion–dissolution technique to create innovative porous booster granules
Information de l’enfant sur son droit d’être entendu dans les procédures familiales : quelles obligations pour les parents et pour le juge ? (commentaire de l’arrêt Cass., 1re civ., 10 décembre 2025, n° 24-11.604)
No full textInternational audienceL’obligation d’informer l’enfant mineur quant à son droit d’être entendu dans la procédure le concernant devant le juge aux affaires familiales, ainsi que celle d’en justifier l’exécution, incombent à ses parents. En l’absence d’une telle justification, ils ne peuvent reprocher aux juges du fond de ne pas s’être assurés que l’enfant a effectivement été informé de son droit, ni de ne pas avoir mentionné dans leur décision que les parents se sont acquittés de leur obligation d’information
Relationship between amyloid choroidopathy and neurological involvement severity scores in transthyretin amyloidosis
No full textInternational audienceBackground: Transthyretin amyloidosis (ATTR) is a disorder characterized by amyloid fibril deposits in various tissues, leading to dysfunction of one or multiple organs. Ocular manifestations include keratoconjunctivitis, secondary glaucoma, vitreous deposits, and amyloid choroidopathy. This study aims to describe the angiographic findings in 40 patients with either hereditary (ATTRv) or wild-type (ATTRwt) transthyretin amyloidosis, analyze the 3-year progression of choroidal involvement, and correlate these findings with neurological and cardiac involvement.Patients and methods: We retrospectively analyzed 79 eyes of 40 patients who underwent a comprehensive ophthalmological examination, including fluorescein angiography and indocyanine green angiography (ICGA), between 2018 and 2021. A neurological assessment (SFN-SIQ questionnaire, PND, FAP, and NIS scores) and cardiology evaluation (NYHA, LVEF) were systematically performed.Results: A total of 25 men and 15 women with a mean age of 65.8±16.8 years were included. Seventy-five percent had ATTRv, mostly with the Val30Met (p.Val50Met) mutation (35%). In 61.1% of cases, hyperfluorescent lesions were observed on ICGA. Only Val30Met (p.Val50Met) patients exhibited firework-like patterns on ICGA. There was no progression of choroidal involvement over 3 years. Ninety-five percent of patients showed neurological involvement. Diffuse choroidal involvement is associated with higher SFN-SIQ questionnaire value (P=0.02), FAP score (P=0.017) and NIS score (P=0.046). In contrast, no relationship was found between cardiac involvement and choroidal involvement.Conclusion: ICG may be used as a marker for neural components of the choroid in this disease. A prospective longitudinal study is needed to evaluate the progression of hyperfluorescent lesions on ICGA in choroidal neuropathy under treatment over time in ATTR
Crop residues moderately influence cumulative N2O emissions through their carbon to nitrogen ratio in a 12-year experiment in northern France
No full textInternational audienceCrop residues and their management are central to the performance of cropping systems. However, we lack information on the extent to which crop residues influence their N₂O emissions, especially over the long term. This knowledge is key as it determines if benefits from crop residue management such as increased carbon storage or soil and water preservation should be weighed against potential stimulation of N 2 O emissions. To lessen this gap, we investigated the effect of crop residue quantity (dry matter yield ranging from 0.29 to 11 t•ha -1 ) and quality (C:N ranging from 8 to 157) on N 2 O emissions and compared it to the effects of other key drivers related to environmental conditions and management practices, such as soil moisture, temperature, and fertilization. We relied on a 12-year dataset of N 2 O emissions from an arable cropping experiment in northern France and implemented an original approach combining definition of "restitution cycles" and use of both linear regression and machine learning algorithms to predict N 2 O emissions at that scale. This allowed to assess the contribution of the various drivers of these emissions, among which crop residue and their management. Our results show that the main drivers of cumulative N 2 O emissions were the amount of mineral nitrogen fertilizer and restitution cycle length. Crop residue characteristics had a relatively minor effect. Among the residue quality indicators, only crop residue C:N ratio affected N 2 O emissions. Tillage, temperature, and water-filled pore space had no detectable or systematic impact. These findings, which are original in terms of the cropping system scale considered, suggest that crop-residue management is not likely to significantly affect N 2 O emissions from arable cropping systems in northern France. They open up opportunities for agricultural decision-making without concern for increased N 2 O emissions as an unwanted trade-off
Electrostatic force regularization for neural structured pruning
No full textInternational audienceThe demand for deploying deep convolutional neural networks (DCNNs) on resource-constrained devices for real-time applications remains substantial. However, existing state-of-the-art structured pruning methods often involve intricate implementations, require modifications to the original network architectures, and necessitate an extensive fine-tuning phase. To address these challenges, we introduce a novel approach that integrates the concept of electrostatic force from physics into the training process of DCNNs. The magnitude of this force is directly proportional to the product of the charges of the convolution filter and the source filter, and inversely proportional to the square of the distance between them. We applied the electrostatic-like force to the convolution filters, attracting those with opposite charges toward non-zero weights and repelling similar ones toward zero. Consequently, repelled filters are pruned as their weights approach zero, while attracted filters retain significant parameters that preserve essential information. Unlike conventional methods, our approach is straightforward to implement, does not require any architectural modifications, and simultaneously optimizes weights and ranks filter importance, all without the need for extensive fine-tuning. We validated the efficacy of our method on modern DCNN architectures using the MNIST, CIFAR, and ImageNet datasets, achieving competitive performance compared to existing structured pruning approaches
Welfare of two cats in a nursing home: impact of the admission of a new resident in a disability unit
No full textInternational audienceObjective: In 2024, domestic cats ( Felis sylvestris catus ) are the most common pets in French homes and nursing homes. In nursing homes, older adults often experience limited social networks, social isolation, and loneliness. The permanent presence of a cat can have positive effects (i.e., reduction in feelings of loneliness and depressive symptoms). As a result, many French nursing homes include resident cats. However, few studies assess the welfare of these animals in such contexts. A cat’s welfare can be impacted by disruptions in the animal’s routine, as observed in nursing homes (i.e., social interactions or environmental changes). This study aimed to assess how the arrival of a new resident in a disability unit of a nursing home affects the welfare and social network of resident cats (Gizmo and Felix). Methods: The study was carried out in a unit with 12 residents, 9 caregivers, and 2 cats. Observations were made over 45 h during a 30-day period, covering three periods: before, during, and after the arrival of a new resident. The cats’ activities and the areas they frequented were recorded using the method of all occurrences sampling. Social proximities between cats, residents, and caregivers were recorded every 10 min using scan sampling to visualize social networks (e.g., for physical contact). Results: Our study showed that the two cats reacted differently to this change. Gizmo spent more time alerting and avoiding others while occupying a new space: the residents’ bedrooms. In contrast, Felix spent less time being active but more time outside the unit. Social network analysis revealed that interactions between caregivers, residents, and the cats were affected. Individuals had the same number of interactions, but not with the same partners. After approximately 10 days, several behaviors showed signs of stabilization; however, not all measures returned to pre−arrival levels, indicating that the adjustment process was still ongoing. Conclusion: Cats and humans began to adjust to environmental changes through behavioral shifts and spatial use, creating feedback loops. Tracking these dynamics via social networks highlights cats as welfare stakeholders. The One Welfare approach emphasizes the importance of architectural flexibility and behavior monitoring to improve multispecies care in nursing homes
"La question du sensus fidei passée au crible du problème du développement dogmatique"
No full textInternational audienc
The M-Tensor Format: Optimality in High Dimensional Regression for Nonlinear Models with Scarce Data
No full textWe present a nonlinear regression framework based on tensor algebra tailored to high dimensional contexts where data is scarce. We exploit algebraic properties of a partial tensor product, namely the m-tensor product, to leverage structured equations with separated variables. The proposed method combines kernel properties along with tensor algebra to prevent the curse of dimensionality and tackle approximations up to hundreds of parameters while avoiding the fixed point strategy. This formalism allows us to provide different regularization techniques fit for low amount of data with a high number of parameters while preserving well-known matrix-based properties. We demonstrate complexity scaling on a general benchmark and dynamical systems to show robustness for engineering problems and ease of implementation